Provider Demographics
NPI:1922430495
Name:LIMCHAIYAWAT, PAULA TESSALEE (OD)
Entity Type:Individual
Prefix:
First Name:PAULA
Middle Name:TESSALEE
Last Name:LIMCHAIYAWAT
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19629 PASEO DE SEVILLA
Mailing Address - Street 2:
Mailing Address - City:WALNUT
Mailing Address - State:CA
Mailing Address - Zip Code:91789-2122
Mailing Address - Country:US
Mailing Address - Phone:909-979-4259
Mailing Address - Fax:
Practice Address - Street 1:334B E 2ND ST
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90012-4203
Practice Address - Country:US
Practice Address - Phone:213-628-7419
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-06
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOEG002795152W00000X
CA14978152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist